Request for Non-ACGME Accredited Training Program | UAMS Graduate Medical Education

Program Information

Program Name:(Required)

Most Closely Related ACGME Specialty Program at UAMS:(Required)

Is there an ACGME Accredited Pathway for this Program?(Required)

Yes

Please Describe Why You Would Not Be Applying Through The ACGME.(Required)

Please List the Accrediting Body for This Program:(Required)

Length of Program in Months:(Required)

Provide the Rationale for the Length of Program if Longer Than One Year:(Required)

Number of Trainees Per Year:(Required)

Prerequisite Education/Training for Entry Into the Program:(Required)

Would This Program Ever Offer a Position to a Candidate that Holds a J-1 Visa?(Required)

Yes

Program Leadership Information

Proposed Program Director Name:(Required)

First Last

Proposed Program Director Email:(Required)

Is Proposed Program Director Candidate a Faculty Member of the Most Closely-Related ACGME Accredited Program(Required)

Yes

Please Provide the Following Information for the Proposed Program Director Candidate:(Required)

Board Certification that Meets Program Requirements

Current Faculty Appointment

Expertise in Proposed Training Program(Required)

Attach Proposed Program Director's CV:(Required)

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 15 MB.

Proposed Program Coordinator Name:(Required)

First Last

Proposed Program Coordinator Email:(Required)

List All Faculty Members Who Have Responsibility for Education or Supervision of the Program:(Required)

Program Rotation Information

Participating Sites for Rotations (UAMS, ACH, VA, etc.):(Required)

Attach Proposed Block Schedule with Participating Site Information.(Required)

Drop files here or

Max. file size: 15 MB.

Download a sample block schedule (PDF).

Program Education Information

Define the Educational Goals of the Program:(Required)

Describe the Required Educational Experiences and Didactic Sessions in the Program:(Required)

Is This Primarily a Research Program?(Required)

Yes

Does the Program Have Procedural Experience Requirements?(Required)

Yes

Program Supervision and Evaluation

Describe the Supervision of Trainees in the Program:(Required)

Describe the Methods of Assessment of Trainees in the Program:(Required)

Impact of Program on Existing ACGME Accredited Programs

Describe the Impact of this Program on the Education of Residents/Fellows in Existing UAMS ACGME Accredited Programs.(Required)

Please Specify Other Trainees:(Required)

In the section below, please provide information on current residents/fellows.

Please identify the number of residents/fellows from existing ACGME accredited programs that will interact with the program’s trainee(s). Enter a number for each year PGY-1 through PGY-8.

PGY-1(Required)